title: Echocardiographic changes and treatment goal rates after a 6-month combined treatment with amlodipine and losartan: a validation study in Andean countries (METAL study).
abstract: BACKGROUND
  The extent to which treatment with amlodipine/losartan may help patients and their doctors from Andean countries to reach their treatment goals remains unknown.
  
  
  METHODS
  We conducted a quasi-experimental, validation study in which patients with primary, uncomplicated hypertension received open-label, fixed combination therapy with amlodipine/losartan 5/50 mg or 5/100 mg according to their baseline blood pressure (BP). The primary outcome was echocardiographic reduction of left ventricular mass (LMV) after 6 months of treatment. Secondary outcomes were changes in BP, uricemia and albuminuria from baseline. We defined patients with adequately controlled hypertension as those with decreases in at least three out of these four variables.
  
  
  RESULTS
  From 109 eligible patients with hypertension, 99 started the protocol (70 under the low-dose combination). Echocardiography indices had mutual correlation and contributed independently to the primary outcome (Cronbach's α index = 0.66). Intention-to-treat analysis showed that 60 patients [60.6%, 95% confidence interval (CI) 50.3-70.3] had reduced LVM. Echocardiographic changes were not associated with dose levels. Favorable changes in BP, uricemia and microabuminuria were seen in 77, 64 and 76 patients respectively. After 6 months there were 64 (95% CI 54-74%) patients with adequately controlled hypertension.
  
  
  CONCLUSIONS
  Every two of three patients of this sample of Andean countries reached adequate control after 6 months of combined antihypertensive treatment with amlodipine/losartan.
authors.affiliation: Fundación Cardioinfantil - Instituto de Cardiología,Bogotá, Colombia.
authors.forename: Juan Guillermo
authors.initials: JG
authors.lastname: Pérez Carreño
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Romero
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Villar Centeno
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000188:drug therapy; D017311:Amlodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D033461:Hyperuricemia / Q000188:drug therapy; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013020:South America; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D017311:Amlodipine; D019808:Losartan
keywords: amlodipine; combined therapy; hypertension; losartan; ventricular hypertrophy